News Briefs: Hospital advocates say Medicare’s 2025 outpatient payment update should have been higher
Medicare payments to hospitals for outpatient services will rise by 2.9% in 2025, according to a final rule published Nov. 1. The update is derived from a 3.4% increase in the market basket and a reduction of 0.5 percentage points as required based on the economywide productivity adjustment. Any hospital that does not fulfill quality-reporting…
A nearly $3 billion settlement with Blue Cross Blue Shield leaves providers with a big choice (updated)
Note: The second section of this article was updated Dec. 5 with news that the proposed settlement has been formally approved. Providers that contract with Blue Cross Blue Shield should assess whether they want to participate in a landmark class-action settlement over litigation stemming from complaints about the insurer’s business practices. In October, a resolution…
Medicare, Medicaid are set to cover GLP-1 drugs under a Biden administration proposal
In a major development for Medicare and Medicaid, the Biden administration has issued a proposal for the program to cover a class of weight-loss drugs that have become increasingly prevalent in society. A proposed rule implementing Medicare Advantage and Medicare Part D technical and policy changes for 2026 includes a provision to reinterpret statutory language…
Biden’s director of Medicaid expresses concern for the program’s future amid talk of block grants
In what amounted to a valedictory for CMS leadership as it has been constituted during the Biden administration, the head of Medicaid expressed concern about the potential for big changes to the program. Daniel Tsai, director of the Center for Medicaid and CHIP services, said the possible transformation to a block-grant program under the incoming…
HHS watchdog flags improper payments to hospitals for services provided to hospice patients
Hospitals may face closer scrutiny over a segment of Medicare outpatient billing after the HHS Office of Inspector General (OIG) found improper payments. In a report posted Nov. 18, OIG found that improper payments were prevalent for outpatient services provided to hospice enrollees during a five-year period ending in 2021. Examining a sample size of…
2 drug manufacturers go to court to turn 340B into a rebate program
Two leading drug manufacturers have pressed forward with efforts to reformat the 340B Drug Pricing Program, filing lawsuits against the federal government over the question of whether savings can be offered as cash rebates rather than up-front discounts. Johnson & Johnson took HHS and the Health Resources and Services Administration (HRSA) to federal court in…
An eventful period for healthcare policy looms as Trump and GOP members of Congress prepare to govern
President-elect Donald Trump and congressional Republicans are expected to implement changes to healthcare policy, including site-neutral payment, price transparency, and modifications to Medicare and Medicaid, while the nomination of Robert F. Kennedy Jr. as HHS Secretary and Mehmet Oz as CMS Administrator could have implications for the healthcare system.
New report: Surging claims denials are undermining working relationships between health systems and health plans
A new report from the Healthcare Financial Management Association reveals that relationships between health systems and health plans have worsened over the past three years, with 80% of surveyed CFOs blaming health plans for increasing denials and claim adjudication errors.
HFMA recognizes 2,075 members who earned certifications in Q3 2024
HFMA now offers 11 certifications for members to validate their expertise and demonstrate their commitment to the profession, including the two recently launched certifications highlighted in bold in the list below. The HFMA certifications are as follows: Multiple certification holders Of the 2,075 people earning certifications in Q3, 101 attained more than one HFMA certification.…
What the site-of-care shift for joint replacement means for hospitals
Hospital patient volumes mostly have been on an upswing since the worst of the COVID-19 pandemic, but certain trends represent cautionary tales for long-term finances. For example, the latest report (registration required) from Strata Decision Technology shows a year-over-year decline in August of more than 21% for inpatient primary knee replacement procedures. A shift to…